Jeanne Bennett, just in her mid-40s, felt young and vital. But her arthritic right hip seemed like it was a thousand years old. Grit your teeth and endure the pain as long as you can, two different orthopedic surgeons advised. Then have a hip replacement.

That wasn't good enough for Bennett, who knew at her age she might wear through two or more prosthetic hips. That would mean multiple surgeries, each more complicated than the last.

Bennett, who lives in Raleigh, tried acupuncture, chiropractic adjustments, physical therapy and massage. Nothing worked. Finally, two years into her search for remedies, she found the answer: hip resurfacing.

The technique, which is being tested in clinical trials at Duke University Medical Center and a handful of other hospitals across the country, offers a fix for hip pain that is long-lasting and less invasive than traditional hip replacement.

The surgery is common in Europe and Asia but is late in arriving in the United States because it must first complete the lengthy process of winning the Food and Drug Administration's approval.

Without FDA approval, most insurers regard resurfacing as an experimental treatment and won't cover it. Bennett and others have obtained care in other countries -- at a huge savings.

In June of last year, Bennett and her husband, John, cashed in frequent-flyer miles and flew to Chennai, India, where Dr. Vijay C. Bose resurfaced Bennett's hip for $5,600, including all hospital fees. India's much lower overhead enables doctors and hospitals to charge a fraction of the cost of similar care in the United States. Bennett said hip resurfacing at Duke, which her insurance refused to cover, would have cost upward of $40,000.

Today, basic activities such as walking and rising from a chair are no longer agonies for Bennett, now 49. The full-time mother is back to hiking, biking and working out at the gym five days a week.

"I do set off metal detectors at the airport now," said Bennett, referring to the cobalt chrome implant in her hip. "That's the worst ramification from my operation."

Experts think resurfacing eventually could replace about 20 percent of hip replacement surgeries, or about 72,000 procedures a year. The market could be even larger, factoring in patients such as Bennett, who refused hip replacement.

Companies that make resurfacing implants are enrolling patients in clinical trials. About a dozen medical centers nationally are participating, and research sites can perform only a few surgeries a month.

Duke, for example, can do just four resurfacing procedures a month under the rules of the two trials in which it is participating. Diane Covington, a physician assistant in Duke's orthopedics department who coordinates the trials, said she gets up to 20 calls a month from patients seeking one of those slots. And that's in spite of the fact that many have to pay out-of-pocket.

"I certainly don't have to talk anybody into it," said Dr. Thomas Vail, the Duke orthopedic surgeon who performs resurfacing surgeries. "There is a lot of consumer interest."

For younger patients

Modern hip resurfacing implants are the latest attempt to provide a way to treat younger patients with disabling hip pain.

Younger patients are often reluctant to accept hip replacement, in which the upper part of the femur, or thighbone, is sawed away and replaced with metal rod attached to a prosthetic joint. Each time a worn implant is replaced with a new one, the surgeon has less bone to work with, making revision surgeries tricky, Vail said.

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